Programs for at-risk students; permissible uses of funding. Includes as covered programs that are eligible for funding under the At-Risk Program initiatives to support both the physical and mental health of students in public schools, including the hiring of licensed practical nurses, registered nurses, and advanced practice registered nurses. This bill is a recommendation of the School Health Services Committee and is identical to HB 195.
Pharmacy benefits managers; requirements; scope; report. Requires all health insurance carriers to use the pass-through pricing model and may limit a pharmacy benefits manager from deriving income from pharmacy benefits management services provided to a carrier except for income derived from a pharmacy benefits management fee. The bill prohibits a pharmacy benefits manager from (i) reversing and or resubmitting the claim of a pharmacist or pharmacy without meeting certain requirements, (ii) reducing any payment to a pharmacist or pharmacy to an effective rate of reimbursement, or (iii) retroactively denying or reducing a claim or aggregate of claims except under certain circumstances. The bill requires the State Corporation Commission (the Commission) to examine the practice of carriers or pharmacy benefits managers requiring or inducing covered individuals to utilize pharmacy services at an affiliated pharmacy. The Commission is required to report its findings and recommendations to the General Assembly by December 1, 2027. Certain provisions of the bill have a delayed effective date of July 1, 2027. This bill incorporates SB 410 and SB 413 and is identical to HB 830.
Health insurance; tobacco surcharge. Eliminates the authority of a health carrier to vary its premium rates based on tobacco use. Under current law, a health carrier may charge premium rates up to 1.5 times higher for a tobacco user than for a nonuser. The provisions of the bill apply to health benefit plans providing individual or small group health insurance coverage entered into, amended, extended, or renewed on or after January 1, 2027.
Health insurance; tobacco surcharge. Eliminates the authority of a health carrier to vary its premium rates based on tobacco use. Under current law, a health carrier may charge premium rates up to 1.5 times higher for a tobacco user than for a nonuser. The provisions of the bill apply to health benefit plans providing individual or small group health insurance coverage entered into, amended, extended, or renewed on or after January 1, 2027. This bill is identical to HB 220.
Life insurance; health insurance; unfair discrimination; pre-exposure prophylaxis for prevention of human immunodeficiency virus. Prohibits any person from refusing to insure, refusing to continue to insure, or limiting the amount or extent of life insurance or accident and sickness insurance coverage available to an individual or charge an individual a different rate for the same coverage based solely on the status of such individual as having received pre-exposure prophylaxis for the prevention of human immunodeficiency virus.
Constitutional amendment (second reference); fundamental right to reproductive freedom. Provides that every individual has the fundamental right to reproductive freedom and that such right shall not be, directly or indirectly, denied, burdened, or infringed upon unless justified by a compelling state interest, as defined in the amendment, and achieved by the least restrictive means. The amendment specifies that, notwithstanding the other provisions of the amendment, the Commonwealth may regulate the provision of abortion care in the third trimester, provided that in no circumstance shall the Commonwealth prohibit an abortion (i) that in the professional judgment of a physician is medically indicated to protect the life or physical or mental health of the pregnant individual or (ii) when in the professional judgment of a physician the fetus is not viable.
Constitutional amendment (second reference); fundamental right to reproductive freedom. Provides that every individual has the fundamental right to reproductive freedom and that such right shall not be, directly or indirectly, denied, burdened, or infringed upon unless justified by a compelling state interest, as defined in the amendment, and achieved by the least restrictive means. The amendment specifies that, notwithstanding the other provisions of the amendment, the Commonwealth may regulate the provision of abortion care in the third trimester, provided that in no circumstance shall the Commonwealth prohibit an abortion (i) that in the professional judgment of a physician is medically indicated to protect the life or physical or mental health of the pregnant individual or (ii) when in the professional judgment of a physician the fetus is not viable.
Positive behavior support facilitators; scope of practice, supervision, and qualifications. Adds positive behavior support facilitators to the professions governed by the Board of Counseling. The bill establishes qualification, scope of practice, and supervision requirements and directs the Board of Counseling to adopt regulations governing positive behavior support facilitators. The bill also directs the Department of Behavioral Health and Developmental Services and the Department of Medical Assistance Services to promulgate regulations that align with the regulations adopted by the Board of Counseling in accordance with the bill.
Health insurance; balance billing protection; emergency medical services vehicle transportation. Prohibits an out-of-network health insurance provider from balance billing any enrollee for transportation provided by an emergency medical services vehicle, defined in the bill as any vehicle, vessel, or aircraft that holds a valid permit issued by the Office of Emergency Medical Services and that is equipped, maintained, or operated to provide emergency medical care or transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless.
Health care providers; required estimate for nonemergency health care services. Requires health care providers to provide a good faith estimate of the payment amount for which the patient will be responsible for such nonemergency health care service, including any fees or other charges for an item or service the patient may reasonably be expected to receive in connection with the nonemergency health care service. The bill requires the good faith estimate to include (i) description of the scheduled nonemergency health care service, (ii) the provider's standard charge for the service and any related item or service, (iii) the provider's standard charges and any contracted rates known at the time the estimate is prepared, and (iv) a statement that the estimate is not binding and the actual amount billed may differ depending on changes in the scope of services or the health carrier's processing of the claim.
